Abstract

MedWire News: Validated tools that measure psychosocial functioning over time in schizophrenia are valuable for monitoring patients and evaluating pharmacological and non-pharmacological treatment strategies, argue UK and Portuguese clinicians.

Although delusions and hallucinations are the most notable symptoms of schizophrenia, the disorder is also characterized by psychosocial function deficits. Studies have shown that the isolated treatment of symptoms is insufficient to restore functioning and quality of life, and, consequently, a greater appreciation of the impact on patients is required.

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Furthermore, Sofia Brissos, from Janssen-Cilag Pharmaceutical in Lisbon, Portugal, and colleagues note that the Diagnostic and Statistical Manual Fourth Edition identifies the measurement of social functioning as an integral part of the assessment of antipsychotic drug therapy in schizophrenia.

Current measures of function do not examine the relationship between cognitive impairment and function. As verbal memory and executive function are known to be strongly linked to occupational functioning, these domains should form a part of assessing such a relationship, the authors argue in the Annals of General Psychiatry.

There are a wide range of instruments available for social functioning assessment. Yet there "is still no real agreement on which scale to use for which purpose," the authors say. This is partly because there are limitations with current tools, such as poor assessment of their psychometric properties and no consensus over the definition and evaluation of social functioning, and because most scales were not developed for schizophrenia.

The most commonly used measure of social functioning is the Global Assessment of Functioning, despite problems over its validity and reliability, and a lack of comprehensive usage guidelines. The Personal and Social Performance scale has, in contrast, been validated in several counties, and suggested as well-suited to the role of assessing antipsychotic trial outcomes. Similarly, the Schizophrenia Outcomes Functioning Interview is reliable and has construct validity.

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While other measures have been developed to assess functioning, the authors say that they are often time-consuming, complex, and require special resources, making them impractical for clinical settings.

However, they write: "The use of validated scales for patients with schizophrenia that are sensitive to change over the course of the illness and of its treatment, will allow a better understanding of patients' functional disabilities, enabling better and more comprehensive monitoring of both pharmacological and non-pharmacological treatment strategies.

"This may lead in time to interventions that are increasingly focused on specific aspects of social functioning with the possibility of improved outcome as a result."